肝移植在肝癌治疗中的地位与评价

以肝移植治疗原发性肝细胞性肝癌(简称肝癌)，应严格地选择适当的病例：单个肿瘤直径不超过5cm，多发性肿瘤直径小于3cm和肿瘤总数不超过3个，肿瘤没有血管和淋巴结侵犯和肝外转移。如果病人患乙型或丙型肝炎，适当地以有效的抗病毒治疗，病人长期存活率可高达79％。这存活率和肝移植治疗良性末期肝硬化十分接近。没有足够证据显示手术前、后辅助性化疗可提高肝移植治疗肝癌的疗效，适量的免疫功能抑制，有助减低肝癌的复发率。如肝癌病人等待肝移植的时间长，可考虑以TACE，射频或微波治疗以减慢肝癌生长速度。肝移植和部分肝切除的长期治疗结果相差不大，在一小部分病人，如肝硬化程度严重，肝移植可比部分肝切除疗效好。肝移植用于治疗纤维板层肝癌和偶然发现肝癌疗效好。由于肝移植对于其它肝肿瘤例如胆管癌，血管肉瘤和转移性肝肿瘤疗效甚差，因此这些肝肿瘤不宜用肝移植作治疗。

Role of liver transplantation in treatment of hepatocellular carcinoma and its evaluation

In carefully selected patients,liver transplantation can be used to treat patients with hepatocellular carcinoma (HCC) with good long-term survival. The usual selection criteria are: single tumour of <5 cm, multiple tumours of <3 in number and <3 cm each, absence of vascular invasion and lymph node involvement, and absence of extrahepatic disease. Using these selection criteria, and provided that the patients receive appropriate antiviral therapy for the underlying hepatitis, a 5-year survival of up to 79% can be achieved. This survival is similar to that achieved in liver transplantation for benign liver diseases. There is no good evidence in the medical literature to suggest that neoadjuvant or adjuvant therapy can help to improve on the results of liver transplantation. Appropriate use of immunosuppressive therapy can result in less tumour recurrence after liver transplantation. If the waiting time between diagnosis and liver transplantation is long (over 2 months), consideration can be given to the use of TACE, radiofrequency ablation or microwave therapy to control the rate of tumour growth during the waiting period. Liver transplantation for HCC produces survival results equivalent to partial hepatectomy. In a subgroup of patients with poor liver function, liver transplantation may produce better results than partial hepatectomy. Liver transplantation gives good results in fibrolamelar HCC. The best results, however, are obtained in incidentoma in which the HCC is only found incidentially in the explanted liver. The results of liver transplantation is so poor for cholangiocarcinoma, angiosarcoma and metastatic tumours that it should not be used to treat these tumours.